Provider Demographics
NPI:1710158597
Name:BEALE, ANN RAY (QMHP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:RAY
Last Name:BEALE
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0015
Mailing Address - Country:US
Mailing Address - Phone:541-997-6261
Mailing Address - Fax:541-997-8606
Practice Address - Street 1:1445 WEST 8TH. ST.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-997-6261
Practice Address - Fax:541-997-8606
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24806101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor